Age_WhiteFor�a 31J Pevise0 t90p
RescriDea Cy @e S�ate
Bwre ol ia. Car.wiissioners
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STATE OF IN
I
I, (We)
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON ON BY MAIL EACH YEAR WITH THE �
COUNiY nUDIiON WHEPE OWNEN'S GROFERTY IS LOCnTED: .
REI.L PflOGENiY - BETWEEN MAHCH 1 ANO MAY 10. INCLUSIVE
MOBILE HOME - BETWEEN JANUARY 1 AND MANCM 3t. INCLUSIVE �����\
(NOT ASSESSEp A$ REAL PPOPERTY) �/ j/ j\/—��
\/ � �J
�/��� COUNTY, SS:
certify that I, (We) was/were
/- � V V
� (,'�
��years of age on the � —. ThaE I, (We) reside at
�f�0 �• _1�U.O.u+�' , � � YY�Q�M e�� � �+"^"""� Township,
ISTREET OR RURAL FOUiE) (C�TY OR TOWN)
� County, Indiana; that I, (We) have owned the following described
{�].,cea�estate
for 1(one) year or more prior to claiming this deduction, and That I, (We)
❑ mobile home
now reside in the premises for which this deduction is claimed:
Surviving Spouse: If application is being made by a surviving unremarried spouse:
Spouse's age at time of death:
Name on property tax records if different from 'above:
Legal Description or Key Number: CA�1V�� � T� ��O
�sessed value of real estate or mobile home as of March 1, current year: ��� �
� /.7%D — J 5�.�0
�
Were either you or your spouse required to file an income tax retum for the preceedRrg �eP?`Yes==��
No If yes, a copy of such return must be submitted for county auditor's ins�PR 2�4 1989
Other than a Mortgage�r Contract Deduction, do you receive any other deduction irom property tax?
"^s NO -� ave you filed application for deduction in this Cour��y�t �
�; No - " • - AUDITOR�
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See Fal�,e Statement Penalty Below: (On Receipt) .
� /�.,-�-i �l q�l D 1. - . � . ' . .
(Owners Full Name)